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Obesity Surgery
Published in: Obesity Surgery 9/2021

01-09-2021 | Obesity | Original Contributions

Impact of the Hepatic Branch of the Vagus Nerve Transection in Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Type 2 Diabetes Mellitus

Authors: Akihiko Sano, Yosuke Seki, Kazunori Kasama, Taiki Nabekura, Yoshimochi Kurokawa, Yasunari Ubukata, Nobuhiro Nakazawa, Keigo Hara, Makoto Sakai, Makoto Sohda, Ken Shirabe, Hiroshi Saeki

Published in: Obesity Surgery | Issue 9/2021

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Abstract

Background

An increase in gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) has been reported, and concomitant hiatal hernia repair (HHR) during LSG is expected to reduce the incidence of post-LSG GERD. In HHR, the hepatic branch of the vagus nerve is anatomically transected. Recent experimental animal models suggest that vagotomy may affect glycemic control and weight loss through a neuroendocrine response.

Objectives

To examine whether LSG with/without hepatic branch vagotomy (HV) has a clinical impact on glycemic control in patients with obesity and type 2 diabetes mellitus (T2DM). Furthermore, the impact on weight loss and post-LSG GERD were evaluated.

Methods

A total of 204 Japanese patients with obesity and T2DM, who underwent LSG and completed 1-year follow-up, were retrospectively analyzed. Operative outcomes, weight loss, glycemic, and GERD-related parameters were compared between the LSG/HHR/HV group (n = 89) and the LSG group (n = 115).

Results

There was no significant difference in the background factors in terms of anthropometric and T2DM-related parameters between the groups. The median operation times in the LSG/HHR/HV and LSG groups were 133 and 124 minutes, respectively (p = 0.236). At 1 year, the diabetes remission rate, HbA1c, fasting glucose, and C-peptide levels were all comparable between the groups. The weight loss effect was also comparable. The patients in the LSG/HHR/HV group achieved significant improvement and prevention of GERD and hiatus hernia (p < 0.001).

Conclusion

HV does not appear to have a clinical impact on glycemic control and weight loss. Concomitant HHR with LSG serves to reduce post-LSG GERD.

Graphical abstract

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Metadata
Title
Impact of the Hepatic Branch of the Vagus Nerve Transection in Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Type 2 Diabetes Mellitus
Authors
Akihiko Sano
Yosuke Seki
Kazunori Kasama
Taiki Nabekura
Yoshimochi Kurokawa
Yasunari Ubukata
Nobuhiro Nakazawa
Keigo Hara
Makoto Sakai
Makoto Sohda
Ken Shirabe
Hiroshi Saeki
Publication date
01-09-2021
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-021-05510-x

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